study of power doppler ultrasound (pdus) to measure response of secukinumab treatment in patients with active psoriatic arthritis (psa)

Conditions: Psoriatic Arthritis

Summary: this study was designed to leverage the sensitivity of ultrasonography available in clinical practice setting to better describe the time course of response to secukinumab (150 mg and 300 mg) on joint synovitis and enthesitis in psa patients with an inadequate response to non-biologic dmards. pdus changes in joint synovitis will be assessed using the global outcome measures in rheumatology (omeract)-european league against rheumatism (eular) synovitis score (gloess) and changes in joint enthesitis were assessed using the omeract enthesitis score.

this was a 52-week, multicenter, international study consisting of a 2 to 4-week screening period, a 12-week randomized, placebo-controlled double-blind treatment period (period 1), a 12-week open-label treatment period (period 2) and a 6-month open-label extension period (period 3). treatment period 1 is a 12-week placebo-controlled, randomized period primarily designed to demonstrate the early and optimal efficacy of secukinumab vs placebo on joint synovitis using pdus via the gloess and global entheseal score after 12 weeks of treatment. the main aim of period 2 was to assess the maintenance or increased magnitude of treatment response on joint synovitis for patients from the original secukinumab groups and to assess the time course of response with secukinumab on joint synovitis in the original placebo group switched to secukinumab from week 12. the main aim of period 3 (extension period) was to allow patients who respond to secukinumab to extend study treatment up to week 52 or until commercial drug becomes available, whichever occurs sooner.

Eligibility criteria:
inclusion criteria: 1. patient must be able to understand and communicate with the investigator and comply with the requirements of the study and must provide written, signed and dated informed consent before any study assessment is performed. 2. male or female patients at least 18 years of age. 3. diagnosis of psa as per caspar with active psa for at least 6 months and a tjc ≥ 3 of 78 and sjc ≥ 3 of 76 at baseline. 4. patients must have a total synovitis pdus score ≥ 2 and inflammation related to pd signal ≥ 1 for at least 2 (affected joints as observed via pdus) of 48 joints at the screening visit and at the baseline visit (before infusion). 5. at least 1 clinically-involved enthesitis site at screening and at the baseline visit (before infusion) defined by sparcc index different from 0. exclusion criteria: 1. chest x-ray or chest mri with evidence of ongoing infectious or malignant process obtained within 3 months prior to screening and evaluated by a qualified physician. 2. previous exposure to secukinumab or other biologic drug directly targeting il-17 or il-17 receptor. 3. any change in the dose of oral corticosteroids in the last 4 weeks prior to the baseline visit or use of i.v. intramuscular or intra-articular corticosteroid during the last 4 weeks prior to the enrollment visit. 4. patients who have previously been treated with tnfα inhibitors (investigational or approved). 5. history of hypersensitivity to the study drug or its excipients or to drugs of similar classes. 6. previous treatment with any cell-depleting therapies including but not limited to anti cd20 investigational agents (e.g. campath, anti-cd4, anti-cd5, anti-cd3, anti cd19). 7. prohibited psoriasis treatments/medications with topical corticosteroids in the last 4 weeks prior to randomization. 8. pregnant or nursing (lactating) women.

Keywords: power doppler ultrasonography psoriatic arthritis enthesitis synovitis outcome measures in rheumatology spondyloarthritis research consortium of canada active psoriatic arthritis secukinumab arthritis gloess monoclonal antibody psa